Learning and Teaching Therapy

Positive reviews are easier to write than negative ones, and this is a difficult review to write. Jay Haley is a pioneer of a radical school of family therapy that originated in the 1950s with anthropologist Gregory Bateson. All psychological illness was formulated to represent purposeful communication between people, and the task of therapy was to understand the symptom as message and reconfigure the communication in a more direct, less pathologic way.

This hypothesis encompassed panic attacks, obsessional rituals, and even psychotic delusions. Symptoms became family affairs, and therapy became the task of naming and solving the specific problem underlying the behavior. Adding to the allure of this radical simplicity was a righteous anti-Freudianism, allowing Haley to cast himself as the David against the evil giant.

Like most psychotherapy "stars," Haley packaged a simple concept, a few useful technical innovations, and pseudo-iconoclastic diatribe and made his mark. And as with many stars, his restatement of the theory has become more shrill with each decade.

The book has something to offend everyone. Psychiatry is all about selecting drugs to bring the patient back under social control (page 156), group therapists follow a mode of treatment because it is "lucrative and fashionable" and are satisfied if their clients do not change (page 42), and Rogerians are cowards who "only teach the therapist to reflect back what the client says" (page 221). Cognitive and marital therapy are likewise harpooned (page 105).

Having leveled the landscape, Haley comes up with his decades-old suggestions. Therapeutically, he continues to be the devotee of Milton Erickson, himself an idiosyncratic, charismatic psychiatrist who managed to have his name enshrined in the role of modern hypnotist. Haley tells a few entertaining anecdotes. For instance, an encoporetic ten-year-old recovers once his parents start paying him $50 each time he soils the bed. An obsessional man stops harassing his wife about housework once she dumps the vacuum-cleaner contents onto the floor of each room she's cleaned.

As for supervision, Haley says it should be done live, with a strategy and plan. Directives and interventions should be prescribed, and prior ways of doing therapy should themselves be treated like symptoms. Haley contends that supervision as currently practiced has allowed generations of therapists to learn nothing but a bankrupt theory through which no one is helped.

Psychotherapy is rife with pioneers whose early contributions were their most valuable. The current work will be enjoyed by cynical managed care types who want to believe that any aspect of the therapeutic relationship is specious. To give Jay Haley a fair reading, I suggest his Problem-Solving Therapy (1) and Uncommon Therapy (2) from the 1970s.

Dr. Mohrer is a consulting psychiatrist at Harbor Health Services in Branford, Connecticut.